| That is a very good question. | | | | around functional department such as |
| | | | laboratory testing, radiology, and medical |
| I am not sure any one thing will 'save' | | | | clinics. Patients travel from one site, queue |
| healthcare. We are in a time of 'white water' | | | | up and after being 'processed' in that |
| change in medicine. New discoveries and new | | | | department are sent to another department. |
| treatments race to the bedside. There will | | | | Thus for a 2 minute blood test, 5 minute |
| instead be a constellation of things that | | | | radiograph of the chest and a 10 minute |
| will improve our healthcare systems. The | | | | doctor's visit the patient may have spent all |
| future of medicine is in the provision of | | | | day go to and from these functional villages. |
| personalized medicine. This is typically | | | | The clinics of the near future should be |
| discussed in relationship to the Humane | | | | organized into a "cellular" model which will |
| Genome project and molecular medicine. | | | | allow all the services to take place within |
| However, it is much more than that. | | | | the clinic, rather than this functional |
| | | | "village' model where patients travel between |
| Personalized medicine is providing the 'right | | | | functions such as lab, clinic and radiology. |
| care at the right time'. Often in the | | | | In the future those functions will be |
| management of chronic conditions care is | | | | provided at the point of care. Personalized |
| arranged 'just in case'. Appointments are | | | | medicine will become the 'right care, at the |
| scheduled into the future 'just in case' you | | | | right time, in the right place'. |
| need to be seen. This is a symptom of the | | | | |
| tradition of medicine that dictated care to | | | | Lean Thinking in healthcare is not just about |
| the patient rather than negotiated care with | | | | how to reduce the administrative burden or |
| the patient. Personalized medicine will | | | | waiting times of the patient. It is also |
| change our healthcare processes dramatically | | | | important to consider the costs that patients |
| in the future. Personalized medicine will | | | | undergo in accessing services. Even if the |
| require our systems to provide 'customized' | | | | patient does not pay personally for their |
| solutions for patients. Medications are | | | | care, there is a cost. Much of that cost is |
| chosen based on a genetic analysis of the | | | | hidden and does not occur in the clinic or |
| patient. Other patient needs will also become | | | | hospital. It occurs as a result of the time |
| important to meet. After hours clinics | | | | and effort to get to the hospital or clinic. |
| already seek to personalize care. Patients | | | | An easy illustration is trouble a patient |
| will be able to request or pull services | | | | undergoes in traveling to the office, finding |
| without long queues. Some systems already | | | | a parking place, then walking to the office |
| allow patients to go online and select their | | | | and then repeating at the other 'villages'. |
| appointment time without ever speaking to a | | | | The travel costs represent a barrier to many |
| clerk. The services they pull will be those | | | | of our patients. Technology solutions will |
| that have value for them. Lean will provide | | | | allow an amendment to the mantra of 'right |
| the basis for understanding the value added | | | | care at the right time' by providing care at |
| activities that will compose personalized | | | | a distance. Telemedicine and telehealth |
| medicine. | | | | combined with point of care testing will be a |
| | | | norm. This will move medicine away from the |
| Lean Thinking is directed at reducing waste. | | | | bricks and mortar of the clinic and hospital. |
| This will allow a greater productivity for | | | | The mantra will become 'the right care, at |
| those value added services. For this reason | | | | the right time, in the right place, using the |
| management science will be as important as | | | | right technology.' |
| basic sciences in the healthcare of the | | | | |
| future. So called 'implementation science' or | | | | Lean thinking actually challenges healthcare |
| 'translational science' is little more than | | | | administrators to develop systems that |
| systematically applying management theory in | | | | provide 'the right care, at the right time, |
| the delivery of evidenced based practices. | | | | in the right place using the right |
| Currently it has been estimated that | | | | technology.' By applying Lean Thinking as new |
| approximately 50% of a clinician's time is | | | | services and buildings are considered all of |
| not necessary and not value added in the eyes | | | | this is possible today. The future is here. |
| of the patient. If this waste is eliminated | | | | But it will take administrators and physician |
| then clinician's will be able to spend more | | | | executives prepared to think lean to fully |
| of their time caring for patients. This will | | | | capitalize on the changes. So you could say |
| reduce frustration for both clinician and | | | | that Lean Thinking will be as important to |
| patient. | | | | 'saving' healthcare as any advance in the |
| | | | biological sciences might be. |
| Currently most facilities are organized | | | | |